Dr Leslie on the Efficacy of Axi-Cel in Relapsed/Refractory MZL

“Even though [axi-cel is] not FDA approved for MZL, it is NCCN recommended to consider axi-cel for patients with relapsed/refractory MZL in the third-line and beyond setting.”

Lori A. Leslie, MD, director, Indolent Lymphoma and Chronic Lymphocytic Leukemia Research Programs, Hackensack Meridian Health’s John Theurer Cancer Center; assistant professor, Hackensack Meridian School of Medicine, discusses the promising efficacy of axicabtagene ciloleucel (axi-cel; Yescarta) in patients with relapsed/refractory marginal zone lymphoma (MZL).

Axi-cel, has shown efficacy forpatients with relapsed/refractory MZL in the phase 2 ZUMA-5 trial (NCT03105336), Lesliebegins. The study evaluated axi-cel in patients with relapsed/refractory indolent non-Hodgkin lymphoma, which included those with follicular lymphoma (n = 127) and MZL (n = 31), she says.

At the 2024 ASH Annual Meeting, 5-year follow-up data from ZUMA-5 were presented, Leslie continues. The presentation provided more detail on patients’ overall response rates (ORRs) and complete remission (CR) rates after receiving axi-cel. Findings showed that, at a median follow-up of 31.8 months (range, 8.3-52.3), the investigator-assessed ORR in patients with MZL (n = 31) was 77% (95% CI, 59%-90%), 65% of which were CRs. She noted that the median duration of response, progression-free survival, and overall survival still have not been met at the 5-year follow-up.

Although axi-cel has not been FDA approved for the treatment of patients with MZL, Leslie clarifies that the the National Comprehensive Cancer Network recommends considering this CAR T-cell therapy for those with relapsed/refractory MZL in the third-line setting and beyond.

In patients with follicular lymphoma, Leslie also notes that all patients experienced similar responses with axi-cel, regardless of their risk factors. These include whether they had disease progression within 24 months or were double-refractory to their alkylating agents or anti-CD20 monoclonal antibodies. She highlights that some of the higher-risk features shown in this patient population are becoming neutralized, notably in patients whose disease was historically associated with poor outcomes.

Moving forward, Leslie says that it’s exciting to have axi-cel as a potential treatment option that can provide long-term responses for patients with poor-risk disease and rarer indolent lymphomas.